An older adult patient has been admitted to the hospital with ...

[Kikoku]

An older adult patient has been admitted to the hospital with suspected Paget disease. What clinical manifestation will help the nurse differentiate Paget disease from other types of muscu-loskeletal diseases?
 
  a. Red, swollen upper and lower extremity joints
  b. Pain on awakening that subsides with ac-tivity
  c. Ataxia or mild hearing loss
  d. Back deformity in the absence of pain

Question 2

A patient is admitted with copious diarrhe
 
  a. The patient is dizzy when standing, and skin assessment reveals abrasions around the perianal area. What assessment finding demonstrates that goals for the priority nursing diagnosis have been met?
  a. Perianal skin abrasions are smaller in size.
  b. Patient does not fall while hospitalized.
  c. Patient sits up without dizziness.
  d. Patient is able to tolerate oral fluids.

[ebe]

Answer to Question 1

C
Manifestations of Paget disease include bone pain, headache and conductive hearing loss (if the skull is affected), barreling of the chest, kyphosis, skull enlargement, and bowing of the tibia and femur. The other manifestations are not those of this disorder.

Answer to Question 2

D
The priority diagnosis for this patient is decreased cardiac output or fluid volume deficit, either of which is evaluated with the lack of dizziness. Falling indicates dehydration or weakness, both brought about by the cardiac output situation. Skin integrity is important but not the priority. Be-ing able to tolerate fluids indicates treatment is going well. However, the priority diagnosis re-lates to cardiac output and fluid volume.